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Management of colon cancer patients: A comprehensive analysis of the absence of multidisciplinary team meetings in two French departments - 29/04/20

Doi : 10.1016/j.clinre.2020.02.020 
Anne-Sophie Foucan a, b, , Pascale Grosclaude c, d, Véronique Bousser e, Eric Bauvin d, f, Denis Smith g, Céline Andre-Fardeau a, Laetitia Daubisse-Marliac c, d, Simone Mathoulin-Pelissier b, h, Brice Amadeo a, b, Gaëlle Coureau a, b, i
a Gironde General Cancer Registry, 33000 Bordeaux, France 
b Inserm Bordeaux Population Health, Research Center U1219, Epicene Team, university of Bordeaux, 33000 Bordeaux, France 
c Claudius Regaud Institute, Regional Cancer Center, IUCT-O, Tarn Cancer Registry, 31059 Toulouse, France 
d LEASP, Inserm U1027, university of Toulouse III, 31000 Toulouse, France 
e Aquitaine Regional Cancer network, 33000 Bordeaux, France 
f Occitanie Regional Cancer network (Onco-Occitanie), 31059 Toulouse, France 
g University hospital of Haut-Lévêque, 33000 Bordeaux, France 
h Inserm CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, 33000 Bordeaux, France 
i Medical Information Service, Public Health Department, university Bordeaux hospital, 33000 Bordeaux, France 

Corresponding author. Inserm Bordeaux Population Health, Research Center U1219, Epicene Team, Gironde General Cancer Registry, university of Bordeaux, 146, rue Léo Saignat, 33076 Bordeaux, France.Inserm Bordeaux Population Health, Research Center U1219, Epicene Team, Gironde General Cancer Registry, university of Bordeaux146, rue Léo SaignatBordeaux33076France
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 29 April 2020
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Highlights

This is one of the first French studies assessing the non-presentation in MDTm, in a context where multidisciplinary team meeting (MDTm) for colon cancer cases is widely implemented.
Among the care management criteria studied, only thoracic CT scan was significantly less frequent in no-MDTm patients taking into account other factors.
Patients not presented in MDTm represent a particular population, more complicated and with little time for diagnosis and care.
The therapeutic care management did not seem to be influenced by the absence of MDTm in these specific patients but rather by the characteristics of the patients and the tumor.

Le texte complet de cet article est disponible en PDF.

Summary

Background

The care management of colorectal cancers has evolved, particularly since the implementation of multidisciplinary team meetings (MDTm). The aim of this study was to identify factors associated with the non-presentation of colon cancer patients in MDTm (no-MDTm) and to assess the association between no-MDTm and the diagnostic and therapeutic care management, in two areas in France, in 2010.

Methods

Patients over 18 years diagnosed for invasive colon cancer in Gironde and Tarn during 2010 were included from the cancer registries of these two departments. We used five indicators to evaluate the care management of colon cancer patients (about diagnosis, treatment and selection of patients for chemotherapy).

Results

No-MDTm patients were more likely to die early after diagnosis (OR=2.94, 95% CI=[1.52–5.66]). Elderly patients and those living in more disadvantaged areas were less often presented in MDTm (OR≥85years=2.10, 95% CI=[1.06–4.18]; OREDI Q4-Q5=1.96, 95% CI=[1.23–3.14]). After adjusting for patient-related variables (age, comorbidities, deprivation) and tumor (stage at diagnosis), we found that thoracic CT scan was less often performed among no-MDTm patients (OR=0.40, 95% CI=[0.24–0.65]). There was no association between the absence of MDTm and the therapeutic care management indicators.

Conclusion

In conclusion, therapeutic care management was not associated with the absence of MDTm but with patient and tumor characteristics, including age, comorbidities and level of deprivation, that influence the non-presentation in MDTm.

Le texte complet de cet article est disponible en PDF.

Keywords : Colon cancer, Multidisciplinary team meeting, Therapeutic care management, European Deprivation Index, Cancer registry


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